advice for patients

Since I’m handing out advice right and left (I think I’ve run out of intern advice, though; maybe next year I’ll have some things to say about annoying interns, of whom I’m sure I’ve been one), maybe I’ll throw out some for patients.

Although really these are more anecdotes about my favorite patients. Out of the whole year, I think my favorite, and best memory, is this one old gentleman who learned my name pat the first time I introduced myself. After that, every time I walked into the room (usually at 5am), his eyes would literally light up. “Dr. Alice! Thank you for coming! It’s so good to see you!” I was almost embarassed to be there, because here I was waking him up, and I hadn’t done a blessed thing for him yet, and he was so happy about it. Actually, I think it started because one of the first days I came to see him, his wound dressing had gotten all disarranged, and he was worrying that when the nurse finally came to change it, it would hurt a lot. I needed to see the wound for myself, so I just changed it quickly and fairly painlessly. Since then, although he kept coming back in with complications, he was always so cheerful and grateful that everyone loved talking to him.

Then there was another lady, who had what you might call a chronic hospital course. She’d stay for a few weeks, go home, come back in less time than it took her to leave, and stay a while longer. When I got signout about her, changing services, I got the phrase “pain issues,” which usually indicates a drug seeker that people have gotten tired of dealing with. For the first couple of days, that seemed to be all there was to it. She had had a lot of surgeries, which resulted in a lot of pain. She’d spent enough time in the hospital to be fairly tolerant to narcotics. But then I started to realize that if I came to talk to her at the times when she wasn’t in as much pain, she was a very nice lady. She wasn’t defeated by all that had happened to her. She worked hard with the physical therapists, and could be often found up moving around by herself. Finally, I realized that she had the same goals we did: despite her complaints of pain, more than anything else she wanted to move away from iv narcotics, and get out of the hospital and back to being independent. At that point it became easy, and she and I worked together as a team to wean down the doses.

Basically, don’t make the doctors and nurses afraid to come in your room. The people who smile when they can, say thank you every now and then, and speak politely, will have nurses come quickly when they call for help, and doctors who come to check on them frequently, and are willing to spend a while discussing plans and alternatives; whereas the patients who make it unpleasant to come into their room will get much more grudging service all around. Unfortunate, and despicably human on our part, but there it is. A little politeness will go a long way towards making your hospital stay smoother and a little more pleasant.

Sometimes when you are sick or in horrendous pain, it is really hard to smile and be polite and obliging to make the lives of medical staff easier… especially if said staff won’t take your concerns seriously, won’t explain things so you can understand, or generally just can’t be bothered. I am not saying you are like that but a lot of medical staff need to also consider what the patient is going through and give them some leeway for not being so easy to get along with.

Bri – I understand what you’re saying; and I’m not asking people who are miserable and sick (the majority of hospital patients, and especially surgery patients) to be cheerful all the time. But I think basic politeness could be asked for. Not everyone has to sit up and say please and thank you when I come to see them; but yelling at the nurse for bringing you your scheduled medications (not for lack of explanation), or cursing the doctor out the minute he sets foot in the room, are not calculated to improve communications. 🙂

Totally obnoxious patients probably are one side of the extreme, while those who manage to give us a nod, a smile or a simple “thanks” can really brighten our days. It’s indeed a clinician’s call to “first, do no harm” (physically and perhaps psychologically). In reality perhaps we need to take into account the fact that doctor is still human — albeit specially trained one — with his/her temperament and preferences; humanity is not always at its best.

I have no understanding of the patients who don’t do everything they can to facilitate their own healing and mood while stuck in the hospital. About 18 months ago, I spent 5 days in the hospital after a burst appendix. I was NPO for all but the last 24 hours and a bit miserable for it (I’m a major water drinker, gallon+ a day), not to mention the 6 inch incision in my stomach, but I did everything I could to get out of there ASAP-I got up and walked around so often they eventually just told me to make sure I hit the call button so someone knew where I was, only laid down when it was required for morning rounds (and spent the rest of the time sitting up so I could avoid wearing pressure cuffs-truly despise those things), used the incentive spirometer multiple times per day, etc, etc, etc.

While the girl in the room next to me (who was 17 (and athletic) to my 35 (and moderately active), and thus should have healed much faster) with a similar issue (had been in a car accident and gone in for abdominal surgery about 30 minutes after I got done for what ended up being relatively minor issues, other than the 6 inch incision) spent as much time as possible in bed, walked exactly one lap around the floor twice a day and was still in and not going home any time soon when I was discharged, despite my added complication of being septic after spending 5 1/2 months with a burst appendix.

It all served to drive home the point to me that, as a patient, I was completely responsible for the speed of my recovery-the doctors handled the medical side and the rest was on me.